AFl, AF, HF, congenital heart diseases

26% of patients are completely asymptomatic

AF

Every 2nd or 3rd beat conducts to ventricles

AFl

Atria is beating 240-400 bpm

AFl

Rapid ventricular rate (150+ bpm)

AFl

In elderly, there is a 30% chance patients with AFl will develop ____

AF

Multiple p waves precede each QRS

AFl

P waves have saw tooth appearance

AFl

R-R intervals usually regular, may become irregular

AFl

Symptoms include: palpitations, shortness of breath, dizziness, syncope

AFl

Chaotic and unsynchronized quivering of atrial myocardium —> rapid, disordered atrial contractions

AF

Atrial rate of 400+ bpm

AF

No distinguishable p waves

AF

Irregularly irregular ventricular rhythm due to AV conduction

AF

Typically narrow QRS

AF

AF terminates spontaneously or with intervention within 7 days, recurrence with variable frequency

Paroxysmal AF

Continuous AF that is sustained > 7 days

Persistent AF

Long term AF >1 yr

Permanent AF

AF in the absence of rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair

Nonvalvular AF

Absence of identifiable disease

Isolated event, or intermittent occurrence

Younger patients, primarily male

Triggers: alcohol, drugs, caffeine, smoking, endurance sports, physical or mental stress, electrolyte abnormalities

Lone (idiopathic) AF

Symptoms:

Recurrent palpitations

Shortness of breath

Chest pain

Dizziness

Increased frequency of urination

Blackout spells

Congestive heart failure

AF

Treatment: stroke prevention, rhythm control, rate control

AF

Anticoagulation

Stroke prevention

Antiarrhythmic meds, cardioversion in addition to anticoagulation, AF ablation

Rhythm control treatment

Meds to control ventricular rate

AV node ablation and pacemaker implant

Rate control treatments

In people over 80, AF is a direct cause of 25% of ____

Strokes

% of blood ejected from the left ventricle with each ventricular contraction

Ejection fraction (EF)

Stroke volume divided by end diastolic volume

Ejection fraction (EF)

In normal hearts, __ ranges between 50-70%

Ejection fraction (EF)

Left side of heart is unable to deliver enough blood to vital body organs

LSHF

Systolic failure: LV loses ability to contract normally, heart cannot efficiently pump blood into circulation

HFrEF

EF =<40%

HFrEF

Diastolic failure: LV loses ability to relax normally (stiff muscle), heart cannot fill with blood during resting period between beats

HFpEF (P = preserved)

EF >= 50%

HFpEF (P = preserved)

In between HFrEF and HFpEF

HFmrEF (mildly reduced)

EF between 41-49%

HFmrEF (mildly reduced)

A previous EF was <= 40% and a follow up EF is >40%

HFimpEF (improved)

Symptomatic HF with baseline LVEF <= 40%, a 10-point inc from baseline LVEF, and 2nd measurement of LVEF >40%

HFimpEF (improved)

SV = EDV - ESV

Stroke volume = end-diastolic volume - end-systolic volume

EF = SV/EDV

Ejection fraction = stroke volume divided by end-diastolic volume

Normal heart (EF 50-70%)

Diastolic dysfunction (HFpEF)

Systolic dysfunction (HFrEF)

RV too weak to pump enough blood to lungs —→ increases venous pressure which pushes fluid into surrounding body tissues —→ cause swelling in legs, abdomen, and body tissues

RSHF

Typically the result of LSHF but can be caused my pulmonary hypertension, pulmonary embolism, and COPD

RSHF

Main causes are:

Hypertension

Abnormal heart valve

CAD

MI

HF

Other causes are:

Congenital heart defects

Familial cardiomyopathy

Infection of heart or valves

Substance abuse

Chemotherapeutic drugs

Rheumatologist or autoimmune disorders

Endocrine or metabolic disorders

Heart rhythm related

Infiltration cardiac disease

Peripartum cardiomyopathy

Stress cardiomyopathy

RV pacing

Electrical dyssynchrony

HF

Shows:

Wide QRS (caused by electrical dyssynchrony)

Damage done to heart

ECG

Shows:

Size of heart

Congestion in lungs

X-ray

Shows:

Objective data about heart valves and function of walls

EF

Echocardiogram

Shows:

Ventricular stretching

Lab tests (beta natriuretic peptide)

No symptoms

Class I

Symptoms with moderate activity

Class II

Symptoms with minimal activity

Class III

Symptoms at rest

Class IV

At risk of heart failure, no structural damage, no symptoms

Stage A

Structural heart damage, no symptoms

Stage B

Structural heart damage, symptomatic

Stage C

End-stage symptoms of HF, normal treatment options do not work

Stage D

Activity, low salt diet, fluid intake, weight control

HF lifestyle changes

Ace-inhibitor, angiotensin receptor blocker, angiotensin receptor/neprilysin inhibitor, beta-blockers, aldosterone antagonist, vasodilators, SGLT-2 inhibitors, digitalis, diuretics

HF drug therapies

valve replacement, heart transplant

HF surgeries

For patients Class II, III, IV heart failure and conduction system defects

CRT device

For patients with class IV HF

Ventricular assist device

Characterized by a back leak of blood from systematic to pulmonary circulation

Left-to-right shunts

Atrial and ventricular septal defects, AV canal defects, patent ductus arteriosus

Types of left-to-right shunts

Some oxygen rich blood passes to right atrium —> extra volume causes damage to heart and lungs

Atrial septal defect (ASD)

75% of ___ occur in middle part of atrial septum

ASD

15-20% of newborns with Down Syndrome have complete ____

AV canal defect

Oxygenated LV and deoxygenated RV blood mix

Ventricular septal defect (VSD)

Can involve ASD, VSD, and tricuspid and mitral valve defects (or all 3)

AV canal defects

A patient with complete _____ has a hole in the center of the heart allowing blood flow between all chambers

AV canal defect

A blood vessel between the aorta and pulmonary artery that fails to close at birth —> increases blood flow to heart and lungs, causing pulmonary hypertension and an enlarged and weakened heart

Patent ductus arteriosus (PDA)

Deoxygenated blood bypasses lungs and flows directly into systemic circulation of the body

Right-to-left shunts

Transposition of the great arteries (TGA)

Tetralogy of Fallot (ToF)

Turn us arteriosus

Total anomalous pulmonary venous return (TAPVR)

Ebstein’s anomoly

Single ventricle defects

Types of right-to-left-shunts

Most common form of cyanotic congenital heart disease (represents ~10% of all cases of congenital heart disease)

ToF

a combination of VSD (hole in ventricular septal wall), PVS (narrowed pulmonary and outflow tract), overriding aorta (aorta is between LV and RV, over the VSD), and RV hypertrophy (thick RV muscle)

ToF

Narrowing of the cardiac valve

Valve stenosis

Valve does not close tightly enough to prevent blood from leaking backwards (aka insufficiency)

Valve regurgitation

May occur at any of the 4 valves

Valve stenosis and regurgitation

Present in 0.3-0.5% of gen pop and 4.5% in people with congenital heart diseases

Malformation of thoracic venous return

Persistent left SVC (PLSVC)